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Mindful EM

Five Things Physicians Should Never Say

Hazan, Alberto MD; Haber, Jordana MD

doi: 10.1097/01.EEM.0000503383.69118.d8
Mindful EM

Dr. Hazanis an emergency physician in Las Vegas and the author of the medical thriller Dr. Vigilante and the preteen urban fantasy series The League of Freaks. Find out more about his novels athttp://amzn.to/1Dug0iG. He is also a board member withwww.givingmore.com. Follow him on Twitter @Dr_Vigilante. Dr. Haberis an emergency physician at University Medical Center in Las Vegas. She has a master's degree in medical education. Follow her on Twitter @JoJoHaber. Read their past articles athttp://emn.online/1UiG4a2.

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There is no consensus on the origin of human language. Because we have no direct evidence about when the evolution of language began, we have to rely on indirect evidence (such as comparisons of contemporary languages, fossil records, and studies of primate communication of the language acquisition). That is why the origin of human language has been deemed by many anthropologists to be “the hardest problem in science.” (Studies in the Evolution of Language, New York: Oxford University Press, 2003; http://bit.ly/2bZfe83.)

Whether you think the origin of language was abrupt or gradual, genetic or learned, it is undeniable that language is essential for everyday life. It is an indispensible aspect of communication, integral to the fabric of society, regardless of whether you use texting or old-school letter writing, signing or verbal sounds.

Words are beautiful. They allow us to paint elaborate pictures in our minds. They can inspire us. They can make us laugh and cry, sometimes at the same time.

The right words in the right order, according to Samuel Taylor Coleridge, make poetry. But the wrong words in any order can mean disaster, especially in the emergency department, where our choice of words is especially important. Our patients, who often come into the ED stressed, in pain, and thinking about worst-case scenarios, literally hang on every word we say. Choosing our words wisely is critical.

Often we hear certain things being uttered in the ED that make us cringe because they are inappropriate and unprofessional. Sometimes we may say things without considering the full implications behind our words. If you're saying any of the following phrases, please reconsider.

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1. “We need to move the meat.”

This is the most demoralizing way to describe your desire to see patients efficiently or to handle a busy waiting room. A layperson overhearing himself referred to as “meat” will not only be turned off but also enraged. And he will have every right to be. The term is disgusting, unprofessional, and distasteful.

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2. “I'll get rid of him.”

This is equally offensive. We know we mean that we'll discharge the patient soon, but to say we'll get “rid of him” or we'll “get him out of here” is unprincipled.

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3. “There is nothing wrong with you.”

Just because the workup was normal doesn't mean there is nothing wrong with the patient. It likely means that at this time there doesn't appear to be any life-threatening illness or anything requiring immediate surgical intervention. Instead of telling someone nothing is wrong, we should actually go over the laboratory and imaging results, pointing out what each of them tells us about his current medical state. Say something like, “We got back your results, and everything appears to be in the normal range. We ran a CBC, which tests your blood counts. The white cell count, which looks at major infections, came back in the normal range. The hemoglobin result shows that you're not anemic. Your platelets, which are responsible for clotting, are normal. We also ran a basic metabolic panel, which looks at your electrolytes, which are within the normal range — your sodium, chloride, potassium, and calcium. Your kidneys are working well based on the creatinine level. Your glucose is normal, which means that at this point there is no reason to believe you have diabetes. The CT scan of your abdomen and pelvis was read as normal. There are no kidney stones, no abscess, no appendicitis. Your liver and spleen are normal in size.”

Following this, your standard detailed return precautions would likely make them feel equally reassured.

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4. “The other doctor was wrong.”

Health care has good physicians and bad physicians. We all know doctors out there whose management we question. But when caring for a patient in the ED, nothing is gained by throwing another physician under the bus. We often don't have the full story of what transpired during the previous visit. It makes patients lose faith in doctors in general when we blame other physicians. We should concentrate on delivering good care to the patient in front of us. Instead of criticizing the other doctor, we can say something like, “I'm not sure what happened during your previous evaluation, but let's focus on what's going on today.”

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5. “There are patients sicker than you.”

It may be frustrating to deal with a demanding patient with an ankle sprain when we are trying to keep someone with diabetic ketoacidosis from going into cardiac arrest, but telling a patient he is not sick enough to warrant an ED visit is unprofessional. Patients have no idea of the relativity of sickness. Sometimes they think they have cancer. Often, they are scared and anxious. They're in pain (an ankle sprain can have 10/10 pain). We should never compare them with others or trivialize their complaints. A patient with a sprained ankle or a migraine headache should be treated with as much compassion as a person who presents in cardiac arrest.

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